清晰與模糊：家有精神病人的復元之路

Abstract

本文是一篇以「復元之路 (recovery journey) 」為題的民族誌，透過探索精神康復者出院以後的日常生活，以及他們實際經驗「復元」的過程。對於公共衛生與精神醫療服務提供者而言，介入服務通常被視為一套具有標準且目標導向的過程，藉由提供充足的服務及橫向轉介，方得建構完善的照護體系。具體而言，一位康復者從住院期間出院準備、規律返回門診、銜接精神復健或就業訓練等，反映公共衛生試圖描繪的清晰樣貌。 民族誌的材料主要來自於 2024年 3 名康復者和 3 名主要照顧家屬的深度訪談，以及田野筆記和相關歷史文獻。本民族誌顯示，康復者的「復元之路」並未如公共衛生所設想般「清晰」；相反地，他們的日常生活往往是動態、多面且糾纏的，是以單一目標的介入無以回應他們的實際情境。另外，即便家庭會影響「復元之路」──尤其對華人而言──，既有介入仍側重於「個人」，而罕有納入家庭與康復者的互動。儘管公衛制度歷經多次修補與強化，例如引入具個案管理意義的關懷訪視員，或開始強調「復元導向服務 (recovery-oriented services) 」，介入始終難以走入康復者的日常生活。 至此，本文並非主張要將復元之路的「模糊」視為一個「待處理的偏差」，而是承認它是難以避免的特質，由此重新審視公衛介入的意涵。本文將提出實踐「關懷倫理 (the ethics of care) 」是回應「模糊」的一種可行方式。 關懷倫理主張倫理並非標準原則，而是要在具體關係中展開關懷的實作過程，並肯認情感的倫理價值。故而公衛服務提供者不是理性「藥物守門人」和「轉介資訊的窗口」，而是和服務使用者建立關懷關係，並一起探索各種可能性，與人類學家 Annemarie Mol 主張的「照護的邏輯 (the logic of care) 」相互呼應。 最後本文試圖歸結，若公共衛生以實踐關懷倫理為核心，其初級預防工作將是「心理健康促進」，而非「疾病預防模式」，兼具廣泛性與彈性的作法能回應康復者及其家庭，在日常生活中所面對的複雜處境。因此，心理健康促進將無可避免地觸及社區、友伴、伴侶、家庭等人際關係，亦會重構公衛的照護意涵。

This ethnographic study explores the recovery journey of individuals with mental illness, focusing on their everyday lives after discharge and the ways in which they experience “recovery” in practice. In public health and psychiatric service contexts, intervention is often conceptualized as a standardized, goal-oriented process, where a comprehensive care system is constructed through sufficient services and inter-organizational referrals. From discharge planning during hospitalization to outpatient follow-ups and connections to psychiatric rehabilitation or vocational training, this idealized trajectory reflects a clear, linear model envisioned by public health systems. Drawing on in-depth interviews with three mental health service users and three primary caregivers conducted in 2024, as well as fieldnotes from participant observation and historical documents, this ethnography reveals that recovery is far from a clear-cut path. Instead, service users’ daily lives are dynamic, multifaceted, and entangled. Although family plays a significant role in shaping the recovery process, particularly in Chinese cultural contexts, existing interventions remain predominantly individual-centered, often overlooking the relational dynamics between service users and their families. Despite several institutional reforms—including the implementation of case management through outreach services and the promotion of recovery-oriented care—interventions continue to fall short of engaging with the lived complexities of everyday recovery. This study does not treat the ambiguity of recovery as a deficit to be corrected, but rather as an inherent condition that invites a rethinking of public health intervention itself. To this end, the paper proposes the ethics of care as a meaningful approach to address such ambiguity. The ethics of care emphasizes the values of rapport and sentimental connection. Public health practitioners are thus reimagined not as rational gatekeepers of medication or referral systems, but as relational actors who co-explore possibilities with service users—echoing anthropologist Annemarie Mol’s logic of care. In conclusion, if public health systems are to embrace the ethics of care, primary prevention must shift from a disease-prevention paradigm to one centered on mental health promotion. Such an approach would be broad, flexible, and capable of responding to the complex, everyday realities faced by service users and their families. Mental health promotion would thus necessarily engage with relational spheres such as community, friendship, partnership, and family—thereby reconfiguring the very meaning of care in public health.